Patients have a right to clean and safe treatment wherever and whenever they are treated by the National Health Service (NHS).⁵ Around 320,000 healthcare-associated infections occur every year (almost 3 million during the decade from 1993). These infections add an average of 11 days of hospitalisation for each person infected and cost the NHS an estimated £1 billion annually. Around a third of these infections could probably have been prevented.⁶ The application of evidence-based infection prevention and control into every day practice is believed to be important in reducing preventable infections and could reduce the human and financial costs.⁷ Health-care professionals should routinely apply the principles of infection control to the management of every patient/client.

Several studies have demonstrated a clear link between handwashing and a reduction in infection^8-11 and, although these studies are hospital based, it is useful and reasonable to extrapolate the findings and apply them to the community setting. Expert opinion is consistent in asserting that effective handwashing reduces the number of pathogens carried on the hands and that this will logically decrease the incidence of preventable HCAI.^12-14

Currently there is no compelling evidence to favour the general use of antimicrobial handwashing agents over soap, or one antimicrobial agent over another.⁴ The acceptability of any preparation used in the community setting will need to be based upon ease of use and their dermatological effect; in most cases this will be determined by the employing Trust.

The latest recommendations from NICE⁴ state that hands that are visibly soiled or potentially grossly contaminated with dirt or organic material must be washed with liquid soap and water. Hands must be decontaminated, preferably with an alcohol-based hand rub unless hands are visibly soiled, between caring for different patients or between different care activities for the same patient.

There is little high level evidence to support any given handwashing technique in terms of duration of washing and hand drying. Current guidelines are based on expert opinion that suggest that the time taken to decontaminate the hands, the exposure of all aspects of the hands and wrists to the decontaminant, the use of vigorous rubbing, thorough rinsing (in the case of handwashing), and drying are all key factors in the process of effective hand hygiene.^12,15

Recommendations⁴

Most expert opinion regarding the use of personal protective equipment (PPE) has been based on studies in the hospital environment; however, it is safe to extrapolate the general findings and apply them to the community setting. This section discusses gloves, aprons, visors/eye protection, and face masks. The purpose of PPE is to protect both patients and staff, and to reduce the risk of transmission of microorganisms.^18,19 The decision to use PPE and the level of PPE is based upon an assessment of the anticipated risk of transmission of micro-organisms to the patient, and the risk of exposure to body fluid during patient management.